Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC

Facility

$68,271.63

Service Code	MSDRG 357
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$68,271.63
Rate for Payer: Aetna of CA HMO/PPO	$68,271.63
Rate for Payer: EPIC Health Plan Commercial	$56,834.82
Rate for Payer: EPIC Health Plan Senior	$42,099.87
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$42,099.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$42,099.87
Rate for Payer: Molina Healthcare of CA Medicare	$56,413.83
Rate for Payer: Multiplan WC	$42,070.64
Rate for Payer: Prime Health Services WC	$41,641.34
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC

Facility

$129,318.96

Service Code	MSDRG 356
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$129,318.96
Rate for Payer: Aetna of CA HMO/PPO	$129,318.96
Rate for Payer: EPIC Health Plan Commercial	$85,428.78
Rate for Payer: EPIC Health Plan Senior	$63,280.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$63,280.58
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$63,280.58
Rate for Payer: Molina Healthcare of CA Medicare	$84,795.98
Rate for Payer: Multiplan WC	$79,689.47
Rate for Payer: Prime Health Services WC	$78,876.32
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$44,099.09

Service Code	MSDRG 358
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$44,099.09
Rate for Payer: Aetna of CA HMO/PPO	$41,081.21
Rate for Payer: EPIC Health Plan Commercial	$44,099.09
Rate for Payer: EPIC Health Plan Senior	$32,665.99
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$32,665.99
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,665.99
Rate for Payer: Molina Healthcare of CA Medicare	$43,772.43
Rate for Payer: Multiplan WC	$25,315.24
Rate for Payer: Prime Health Services WC	$25,056.92
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: OTHER DISORDERS OF NERVOUS SYSTEM WITH CC

Facility

$39,890.30

Service Code	MSDRG 092
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$39,890.30
Rate for Payer: Aetna of CA HMO/PPO	$32,095.55
Rate for Payer: EPIC Health Plan Commercial	$39,890.30
Rate for Payer: EPIC Health Plan Senior	$29,548.37
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,548.37
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,548.37
Rate for Payer: Molina Healthcare of CA Medicare	$39,594.82
Rate for Payer: Multiplan WC	$19,778.06
Rate for Payer: Prime Health Services WC	$19,576.24
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC

Facility

$55,263.04

Service Code	MSDRG 091
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$55,263.04
Rate for Payer: Aetna of CA HMO/PPO	$55,263.04
Rate for Payer: EPIC Health Plan Commercial	$50,741.72
Rate for Payer: EPIC Health Plan Senior	$37,586.46
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,586.46
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,586.46
Rate for Payer: Molina Healthcare of CA Medicare	$50,365.86
Rate for Payer: Multiplan WC	$34,054.42
Rate for Payer: Prime Health Services WC	$33,706.93
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC

Facility

$36,064.90

Service Code	MSDRG 093
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$36,064.90
Rate for Payer: Aetna of CA HMO/PPO	$23,928.42
Rate for Payer: EPIC Health Plan Commercial	$36,064.90
Rate for Payer: EPIC Health Plan Senior	$26,714.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,714.74
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,714.74
Rate for Payer: Molina Healthcare of CA Medicare	$35,797.75
Rate for Payer: Multiplan WC	$14,745.28
Rate for Payer: Prime Health Services WC	$14,594.81
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT

Facility

$43,372.08

Service Code	MSDRG 124
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$43,372.08
Rate for Payer: Prime Health Services WC	$24,110.18
Rate for Payer: Aetna of CA HMO/PPO	$39,529.03
Rate for Payer: EPIC Health Plan Commercial	$43,372.08
Rate for Payer: EPIC Health Plan Senior	$32,127.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$32,127.47
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,127.47
Rate for Payer: Molina Healthcare of CA Medicare	$43,050.81
Rate for Payer: Multiplan WC	$24,358.74
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: OTHER DISORDERS OF THE EYE WITHOUT MCC

Facility

$36,581.77

Service Code	MSDRG 125
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$36,581.77
Rate for Payer: Aetna of CA HMO/PPO	$25,031.92
Rate for Payer: EPIC Health Plan Commercial	$36,581.77
Rate for Payer: EPIC Health Plan Senior	$27,097.61
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,097.61
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,097.61
Rate for Payer: Molina Healthcare of CA Medicare	$36,310.80
Rate for Payer: Multiplan WC	$15,425.28
Rate for Payer: Prime Health Services WC	$15,267.88
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC

Facility

$38,113.93

Service Code	MSDRG 155
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$38,113.93
Rate for Payer: Aetna of CA HMO/PPO	$28,303.02
Rate for Payer: EPIC Health Plan Commercial	$38,113.93
Rate for Payer: EPIC Health Plan Senior	$28,232.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,232.54
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,232.54
Rate for Payer: Molina Healthcare of CA Medicare	$37,831.60
Rate for Payer: Multiplan WC	$17,441.00
Rate for Payer: Prime Health Services WC	$17,263.03
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC

Facility

$49,302.91

Service Code	MSDRG 154
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$49,302.91
Rate for Payer: Aetna of CA HMO/PPO	$49,302.91
Rate for Payer: EPIC Health Plan Commercial	$47,950.07
Rate for Payer: EPIC Health Plan Senior	$35,518.57
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,518.57
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,518.57
Rate for Payer: Molina Healthcare of CA Medicare	$47,594.88
Rate for Payer: Multiplan WC	$30,381.65
Rate for Payer: Prime Health Services WC	$30,071.63
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC

Facility

$34,404.95

Service Code	MSDRG 156
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$34,404.95
Rate for Payer: Aetna of CA HMO/PPO	$20,384.48
Rate for Payer: EPIC Health Plan Commercial	$34,404.95
Rate for Payer: EPIC Health Plan Senior	$25,485.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,485.15
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,485.15
Rate for Payer: Molina Healthcare of CA Medicare	$34,150.10
Rate for Payer: Multiplan WC	$12,561.40
Rate for Payer: Prime Health Services WC	$12,433.23
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC

Facility

$53,256.12

Service Code	MSDRG 144
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$53,256.12
Rate for Payer: Aetna of CA HMO/PPO	$53,256.12
Rate for Payer: EPIC Health Plan Commercial	$49,801.70
Rate for Payer: EPIC Health Plan Senior	$36,890.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$36,890.15
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,890.15
Rate for Payer: Molina Healthcare of CA Medicare	$49,432.80
Rate for Payer: Multiplan WC	$32,817.71
Rate for Payer: Prime Health Services WC	$32,482.84
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC

Facility

$100,100.40

Service Code	MSDRG 143
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$100,100.40
Rate for Payer: Aetna of CA HMO/PPO	$100,100.40
Rate for Payer: EPIC Health Plan Commercial	$71,743.10
Rate for Payer: EPIC Health Plan Senior	$53,143.04
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$53,143.04
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$53,143.04
Rate for Payer: Molina Healthcare of CA Medicare	$71,211.67
Rate for Payer: Multiplan WC	$61,684.30
Rate for Payer: Prime Health Services WC	$61,054.87
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC

Facility

$41,680.89

Service Code	MSDRG 145
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$41,680.89
Rate for Payer: Aetna of CA HMO/PPO	$35,918.40
Rate for Payer: EPIC Health Plan Commercial	$41,680.89
Rate for Payer: EPIC Health Plan Senior	$30,874.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,874.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,874.73
Rate for Payer: Molina Healthcare of CA Medicare	$41,372.14
Rate for Payer: Multiplan WC	$22,133.79
Rate for Payer: Prime Health Services WC	$21,907.94
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC

Facility

$68,183.72

Service Code	MSDRG 629
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$68,183.72
Rate for Payer: Aetna of CA HMO/PPO	$68,183.72
Rate for Payer: EPIC Health Plan Commercial	$56,793.65
Rate for Payer: EPIC Health Plan Senior	$42,069.37
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$42,069.37
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$42,069.37
Rate for Payer: Molina Healthcare of CA Medicare	$56,372.96
Rate for Payer: Multiplan WC	$42,016.46
Rate for Payer: Prime Health Services WC	$41,587.72
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC

Facility

$119,617.84

Service Code	MSDRG 628
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$119,617.84
Rate for Payer: Aetna of CA HMO/PPO	$119,617.84
Rate for Payer: EPIC Health Plan Commercial	$80,884.89
Rate for Payer: EPIC Health Plan Senior	$59,914.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$59,914.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$59,914.73
Rate for Payer: Molina Healthcare of CA Medicare	$80,285.74
Rate for Payer: Multiplan WC	$73,711.42
Rate for Payer: Prime Health Services WC	$72,959.26
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC

Facility

$44,755.13

Service Code	MSDRG 630
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$44,755.13
Rate for Payer: Aetna of CA HMO/PPO	$42,481.81
Rate for Payer: EPIC Health Plan Commercial	$44,755.13
Rate for Payer: EPIC Health Plan Senior	$33,151.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,151.95
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,151.95
Rate for Payer: Molina Healthcare of CA Medicare	$44,423.61
Rate for Payer: Multiplan WC	$26,178.32
Rate for Payer: Prime Health Services WC	$25,911.19
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC

Facility

$133,172.12

Service Code	MSDRG 319
Min. Negotiated Rate	$56,595.00
Max. Negotiated Rate	$133,172.12
Rate for Payer: Aetna of CA HMO/PPO	$133,172.12
Rate for Payer: EPIC Health Plan Commercial	$87,233.58
Rate for Payer: EPIC Health Plan Senior	$64,617.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$64,617.47
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$64,617.47
Rate for Payer: Molina Healthcare of CA Medicare	$86,587.41
Rate for Payer: Multiplan WC	$82,063.89
Rate for Payer: Prime Health Services WC	$81,226.50
Rate for Payer: United Healthcare All Other Commercial	$86,080.00
Rate for Payer: United Healthcare All Other HMO	$77,662.00
Rate for Payer: United Healthcare HMO Rider	$61,775.00
Rate for Payer: United Healthcare Select/Navigate/Core	$56,595.00

MS-DRG 42.00: OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC

Facility

$70,175.48

Service Code	MSDRG 320
Min. Negotiated Rate	$32,402.00
Max. Negotiated Rate	$70,175.48
Rate for Payer: Aetna of CA HMO/PPO	$70,175.48
Rate for Payer: EPIC Health Plan Commercial	$57,726.57
Rate for Payer: EPIC Health Plan Senior	$42,760.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$42,760.42
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$42,760.42
Rate for Payer: Molina Healthcare of CA Medicare	$57,298.96
Rate for Payer: Multiplan WC	$43,243.83
Rate for Payer: Prime Health Services WC	$42,802.57
Rate for Payer: United Healthcare All Other Commercial	$49,280.00
Rate for Payer: United Healthcare All Other HMO	$44,464.00
Rate for Payer: United Healthcare HMO Rider	$35,366.00
Rate for Payer: United Healthcare Select/Navigate/Core	$32,402.00

MS-DRG 42.00: OTHER FACTORS INFLUENCING HEALTH STATUS

Facility

$32,908.30

Service Code	MSDRG 951
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$32,908.30
Rate for Payer: Aetna of CA HMO/PPO	$17,189.17
Rate for Payer: EPIC Health Plan Commercial	$32,908.30
Rate for Payer: EPIC Health Plan Senior	$24,376.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,376.52
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,376.52
Rate for Payer: Molina Healthcare of CA Medicare	$32,664.54
Rate for Payer: Multiplan WC	$10,592.39
Rate for Payer: Prime Health Services WC	$10,484.30
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC

Facility

$78,476.00

Service Code	MSDRG 749
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$78,476.00
Rate for Payer: Aetna of CA HMO/PPO	$78,476.00
Rate for Payer: EPIC Health Plan Commercial	$61,614.45
Rate for Payer: EPIC Health Plan Senior	$45,640.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$45,640.33
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$45,640.33
Rate for Payer: Molina Healthcare of CA Medicare	$61,158.04
Rate for Payer: Multiplan WC	$48,358.82
Rate for Payer: Prime Health Services WC	$47,865.36
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$43,167.60

Service Code	MSDRG 750
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$43,167.60
Rate for Payer: Aetna of CA HMO/PPO	$39,092.48
Rate for Payer: EPIC Health Plan Commercial	$43,167.60
Rate for Payer: EPIC Health Plan Senior	$31,976.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,976.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,976.00
Rate for Payer: Molina Healthcare of CA Medicare	$42,847.84
Rate for Payer: Multiplan WC	$24,089.73
Rate for Payer: Prime Health Services WC	$23,843.92
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: OTHER HEART ASSIST SYSTEM IMPLANT

Facility

$321,191.96

Service Code	MSDRG 215
Min. Negotiated Rate	$129,852.03
Max. Negotiated Rate	$321,191.96
Rate for Payer: Aetna of CA HMO/PPO	$321,191.96
Rate for Payer: EPIC Health Plan Commercial	$175,300.24
Rate for Payer: EPIC Health Plan Senior	$129,852.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$129,852.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$129,852.03
Rate for Payer: Molina Healthcare of CA Medicare	$174,001.72
Rate for Payer: Multiplan WC	$197,926.27
Rate for Payer: Prime Health Services WC	$195,906.61
Rate for Payer: United Healthcare All Other Commercial	$200,732.00
Rate for Payer: United Healthcare All Other HMO	$207,861.00
Rate for Payer: United Healthcare HMO Rider	$157,887.00
Rate for Payer: United Healthcare Select/Navigate/Core	$144,650.00

MS-DRG 42.00: OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC

Facility

$69,220.52

Service Code	MSDRG 424
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$69,220.52
Rate for Payer: Aetna of CA HMO/PPO	$69,220.52
Rate for Payer: EPIC Health Plan Commercial	$57,279.26
Rate for Payer: EPIC Health Plan Senior	$42,429.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$42,429.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$42,429.08
Rate for Payer: Molina Healthcare of CA Medicare	$56,854.97
Rate for Payer: Multiplan WC	$42,655.36
Rate for Payer: Prime Health Services WC	$42,220.10
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC

Facility

$123,307.30

Service Code	MSDRG 423
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$123,307.30
Rate for Payer: Aetna of CA HMO/PPO	$123,307.30
Rate for Payer: EPIC Health Plan Commercial	$82,612.98
Rate for Payer: EPIC Health Plan Senior	$61,194.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$61,194.80
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$61,194.80
Rate for Payer: Molina Healthcare of CA Medicare	$82,001.03
Rate for Payer: Multiplan WC	$75,984.95
Rate for Payer: Prime Health Services WC	$75,209.59
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

Know your out-of-pocket cost for care.

All Charges